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is designed to increase the supply of and hearings. Another similar program sional assistance program; the gentlemedical manpower and to improve the was also provided in the National De- man is correct. quality of medical manpower in the fense Education Act of 1952, when fel- Mr. SMITH of California. I think we United States in the future. The bill was lowships up to $2,500 per year were are in agreement; I thank the gentleman, reported by the committee, after the granted to advanced students for degrees Madam Chairman. usual hearings and careful consideration, beyond the baccalaureate.

Mr. HARRIS. We feel that in this unanimously. We think it represents a I would remind our friend and col- profession there is just as great a need, sound and reasonable approach to a league from California (Mr. SMITH), a if there is any way that you can comtremendous problem for the whole coun- member of the Committee on Rules, who pare it, as there is in any other profestry.

raised the question a few minutes ago, sion in our entire society. Now, as has been related to you by that what we are doing here is not a new

Madam Chairman, the committee conmembers of the Committee on Rules who idea at all. We are carrying a program sidered this at some length and finally have briefly discussed this proposal, there forward which this Congress inaugurated arrived at this conclusion. We did not are four programs contained in the bill. some years ago, but we are extending it 3 years ago when this bill was first apFirst, we provide assistance for the con- to a new field. It is a well known and proved include scholarships, because we struction of schools for the training of recognized fact that it takes about 10

were not convinced that this was neceshealth professions manpower. This years to educate a doctor from the time sary. However, it is like some of the means doctors, dentists, osteopaths, pro- he starts his school program until he other programs now. After we have had fessional public health personnel, op- completes his training and education and a few years' experience we have come to tometrists, podiatrists, and pharmacists. is then ready to serve the sick and ill of the conclusion that it is necessary if we This is an extension of the existing pro- our country.

are going to meet the need. gram which was approved by this House We are seeing today out of our experi

Madam Chairman, the fourth program in 1963.

ence that it is becoming more and more provided in the bill is a program for what The second program contained in the difficult for capable applicants entering is called basic and special improvement bill provides for student loans for stu- the schools of medicine and the health grants to schools in the health profesdents at health professions schools. This field to finance their education. Pri- sions field to enable them to strengthen is also an extension of the present pro- marily this is because of the cost and the their programs of teaching students. gram, with which, no doubt, the Mem- length of time it takes to complete train

Madam Chairman, the testimony prebers of this House are familiar.

ing, which is far beyond that of any other sented to the committee during the hearNow, there are two additional pro- profession in this country. Consequently ings, and summarized in the committee grams, Madam Chairman, provided in we have felt that we are not catching up, report to which I invite your attention, the bill that are new, insofar as they re

we are not meeting the demands and the demonstrates the clear need for this new late to schools teaching persons in the needs of our people. Even though other program, health professions field. I call to your programs of student aid are available

Now, I shall ask permission to revise attention that we are authorizing a sys- through well-known, altruistic people, and extend my remarks, and take up tem of grants to the schools which may who have made money available out of each one of these four programs and exbe used by them in granting scholar- their own savings, and even though great plain them, construction assistance, the ships to persons studying in the health organizations such as the American Med

student loan program, scholarship field. This is not a new idea, even though ical Association offer loan programs, and grants, and these basic and special imit is a new program insofar as concerns even though there are some business or

provement grants which I have briefly the health fields.

ganizations that offer scholarships, still summarized to you. Mrs. BOLTON. Madam Chairman, we are not meeting all of the needs.

CONSTRUCTION ASSISTANCE will the gentleman yield for a question?

There are many fine potential students, Madam Chairman, the original Mr. HARRIS. I will be delighted to as one institution after another has told Health Professions Assistance Act of yield to the gentlewoman.

us, people who are interested, but who 1963 has worked extremely well to date. Mrs. BOLTON. It seems to me, and I simply cannot meet the high cost and the Many medical and dental schools have notice this is entirely for the medical end time required, the 10 years that would be submitted applications for construction of things, reading from your report required, to provide necessities for them- assistance, which will, upon the compleThere is nothing said here about schools selves to live and to go ahead with their tion of the construction, provide faciliof nursing. I do not see how a doctor is education in this field.

ties for the training of additional stugoing to function in a hospital unless he

We have had brought to our attention dents. Relying on these increased facilihas plenty of nurses. Mr. HARRIS. As the gentlewoman interested if they were given encouragethe cases of many people who would be ties which will be provided with as

sistance under the original legislation, will no doubt recall, when this act was ment and assistance. In view of this many schools have increased their enauthorized at the outset in 1963, it pro- situation we have decided to try to meet rollment. For example, in 1962 the total vided among other things for construc- this problem.

first year enrollment in medical schools tion assistance for collegiate schools of

Mr. SMITH of California. Madam was 9,200; in September of this year it is nursing. However, if the gentlewoman Chairman, will the gentleman yield?

estimated that this enrollment will total will recall also, we provided a special pro

Mr. HARRIS. I am delighted to yield 9,925. Similarly, dental schools have gram for nurse training in 1964. There- to the gentleman from California.

gone from 3,680 in 1962 to an estimated fore, the nurses come under their own

Mr. SMITH of California. Madam

3,850 this September. program and not under this one. As I Chairman, I concur in the gentleman's

Applications have been approved and remember so well, the gentlewoman contributed so much to that program, which I never make a misstatement when I am one new dental school. It is anticipated

statement, but I want to be certain that funded for six new medical schools and is working out exceedingly well. presenting a rule. Was I correct in stat

that additional medical and dental Mrs. BOLTON, May I say to the gen- ing

that outright grants or scholarships schools will be created under the program tleman I hope when we get to discussing will not have to be repaid, if they are we are presenting to you today. the nursing problem you will permit me granted under that provision?

It has been estimated to us that, by to take some time to say something, because I do not think it is going so well.

Mr. HARRIS. The gentleman is cor- 1975, we will need to have a minimum of rect.

12,700 students admitted to the first year Mr. HARRIS. I will be very glad to have the gentlewoman have the time and

Mr. SMITH of California. We have class in medical schools throughout the

United States in order

in order to produce express her views. never done that before?

graduating classes numbering 11,500. If

Mr. HARRIS. It is new for this proAs I was about to say, this question of

we can obtain this enrollment increase, providing scholarships to persons study- gram, but it is not new in the field of then it will be possible, according to the ing in our institutions is not new at all. education.

best estimates furnished to us for the A similar program was authorized under

Mr. SMITH of California. But it is physician/patient ratio in the United the National Science Foundation Act new in this bill?

States to remain at the current level of which was passed by this Congress about Mr. HARRIS. It is new for medical 149 doctors for every 100,000 Americans. 1950, after several years of consideration schools and in the health and profes- Frankly, I am not sure whether this will be enough since trends in the practice of

SCHOLARSHIP GRANTS

have increased from $146 to $256 million. medicine in recent years have been in the Our committee has also authorized a Students are paying increasingly burdendirection of increased specialization by program of grants to the schools in some amounts of tuition and fees, from doctors, with a declining proportion of amounts ultimately amounting to $2,000 $719 average in 1956–57 to $1,025 average general physicians. It is for this reason, times one-tenth of the total number of in 1962–63. Notwithstanding these inamong others, that we must be alert to students in the schools, which may be creases in tuition and fees, tuition and establishment or continuation of pro- used by the schools to make scholarship fee income now comprises a smaller pergrams under which general practitioners grants to needy students in amounts up centage of the total operating budget, may practice medicine more efficiently to $2,500 a year.

dropped during the period discussed and effectively.

Under present programs, the bright above from 14.3 to 12.6 percent. The Department of Health, Education, college graduate who wants to go on to The average cost of instruction of stuand Welfare made projections for the medical school is faced with a difficult dents increased from $5,026 average per committee of the additional first-year dilemma unless he comes from wealthy year in 1956-57 to $8,000 average in places which will be created under the parents.

parents. More than four-fifths of the 1962–63. State appropriations have inconstruction assistance provisions con- graduate schools in the life sciences re- creased in amount but decreased as a tained in this bill. This information is ceived nonfundable grants in 1962–63 percentage of total operating costs from set out in a table at the bottom of page and the average grant was $2,700. In

$49 million in 1956-57-33.5 percent of 4 of our committee report, and if these contrast, less than one-third of the med- total_to $69.5 million in 1962–63—or 27 projections work out in accordance with ical students received nonfundable

nonfundable percent of total. The same is true of enthe estimates we should, within a few grants of any kind and the average which dowment income which has increased years, upon completion of the construc- they received was $760. Only 15 per- from $13.7 million-10 percent of totaltion provided for in this bill, have in- cent of the dental students received

cent of the dental students received to $20.7 million—7.8 percent of total. creased the number of first-year students scholarships which average $425. Sim- These patterns apply equally to schools in medical schools to almost 12,000 and ilarly, there are relatively few scholar- of dentistry, osteopathy, and optometry. to dental schools to a little over 5,000. ships available to students at schools of It is for this reason that our commit

The legislation also provides assistance optometry and they are in relatively tee was convinced on the basis of the eviin the construction and rehabilitation small amounts averaging out to about

small amounts averaging out to about dence submitted during the hearings that of schools of osteopathy, schools of pub- $350 a year to the students who receive the medical schools in the United States lic health, schools of optometry, schools the scholarships.

need additional financial assistance if of podiatry, and schools of pharmacy.

This means then that a student from they are to continue to serve their teachThe committee was furnished infor- a poor family faces a difficult problem if ing functions.

functions. Our committee has, mation during the hearings both in this he wants to become a doctor or a dentist. therefore, provided a system of grants to Congress and in the two preceding Con- He stands a good chance of getting the schools which are to be used to aid gresses indicating the need for increased scholarship aid in amounts sufficient to the schools to contribute toward the personnel in

in these fields. Funda- meet almost all of his needs if he chooses maintenance of their accreditation or to mentally, the problem which we face in to study for a Ph. D., but if he decides to provide for their accreditation or to conthese areas arises out of the fact that go into the study of medicine his pros- tribute toward the maintenance of the our population is expanding so rapidly pects of receiving scholarship aid are specialized functions which the schools that the facilities to train persons to quite low and the assistance he will re- serves, such as teaching or research, or to meet the health needs of our expanding ceive will be inadequate to meet his needs. provide for these specialized functions. population are not able to expand suffi

Establishing a scholarship program Basic improvement grants are to be ciently to meet the needs except through would, in our opinion, increase the qual- paid to schools in accordance with a forthe establishment of programs of Fed- ity of students at schools of medicine by mula set out under the bill under which eral assistance for these schools.

increasing the number of students who the first year the school will receive STUDENT LOAN PROGRAM

will be able to afford to attend these $12,500 plus $250 for each full-time stuThe original Health Professions Edu- the number of applicants to medical

schools. The program should increase dent enrolled therein; for the second and cational Assistance Act of 1963 estab- schools and enable the schools of medi

the number of applicants to medical subsequent years of the program the lished a program under which student cine, dentistry, osteopathy, and optome

schools and enable the schools of medi- school will receive $25,000 plus $500 for loan funds may be

each student. These grants would be established at

try to compete for brighter students more schools of medicine,

made to the school, without regard to dentistry, and adequately with other disciplines.

whether it is wealthy or poor. It is inosteopathy. Loans may be made to students in these three disciplines up to who are studying at the graduate level

What we are doing for these students tended that in the case of the wealthy $2,000 a year, with provision for a delay is providing for them the same level of

who are studying at the graduate level schools, these grants would be used to aid in repayment of the loans for 3 years Federal support available to them if they

them in strengthening, enriching, and

improving their following completion of his education.

programs. These By later legislation, this program was

pursue graduate work in other areas. schools would use these grants for such extended also to students of optometry.

BASIC AND SPECIAL IMPROVEMENT GRANTS

things as achieving balance in their curOf the 152 schools which are eligible,

Madam Chairman, the program of

riculum areas and for experimenting in

innovations in professional health edu147 have established student loan funds. basic and special improvement grants

cation. Under the bill, the maximum amount which our committee has approved

In the case of the less well-to-do of a loan which may be made to a student for this legislation is a new program,

schools, these grants are critically has been increased to $2,500, the same but it is one that is badly needed amount authorized under the National and one that I support very strongly needed. In a report of a council of the Defense Education Act. The estimates In recent years, costs have been

American Medical Association, it was

stated that the weaker schools lack the furnished the committee indicate that rising in every area, and the costs approximately $25 million a year in ap- have increased drastically. For example, faced by medical schools for teaching

number of faculty members they need.

It was stated that these schools are hanpropriations beginning in the fiscal year in 1956–57, medical schools spent a total

dicapped by their basic financial insta1967 will be needed in order to meet the of approximately $240 million; whereas

bility. The report expresses concern needs of students at these schools, and in the 1962-63 school year these expendi

about the quality of the educational prothe bill authorizes appropriations in this tures had increased to over $600 million.

grams, and states that almost all of the amount. The committee has also au- The Federal Government is, of course,

10 schools with the lowest expenditures thorized the extension of the student loan supporting large amounts of research at

during 1960–61 have been warned of posprogram to schools of podiatry and medical institutions. These amounts in

sible withdrawal of their accreditation. schools of pharmacy, if the Secretary of creased from 1956–57 to 1962–63 from

In the field of dental schools already 3 Health, Education, and Welfare deter- about $90 million to almost $350 million.

about $90 million to almost $350 million. schools have been placed on provisional mines that the needs in this area require During this same period the regular op

accreditation and others are in serious the extension of this program to these erating costs of the schools, where little jeopardy. The schools of osteopathy schools.

if any Federal assistance is provided, have the same basic problems, as do the

schools of optometry. These grants will put. We did not go into great numbers this bill or the amendment offered by aid all schools in improving the quality and percentages. We said 2.5 percent the gentleman from Florida to bring of their teaching programs and thereby each year of additional students to the about a lowering in standards in conimprove the quality of the training of class, or a minimum of five. We feel that nection with nurses' training that is set their graduates.

certainly if we are going to provide forth in this bill, and particularly inasThe special improvement grants will Federal assistance for a program and much as there are additional provisions serve a similar purpose, except that it is our stated objective is to increase man- whereby the program provides for an expected that they will go primarily to power as I explained a moment ago—cer- educational institution which has been the schools with the greatest need. Spe- tainly they can go just this small step in approved or accredited by either an accial improvement grants may be made providing additional manpower.

credited agency or a State-approved up to $100,000 per school for the current It is just that simple. There are some agency shall not be so expanded as to fiscal year; $200,000 for the next fiscal institutions, including my own in the make it possible for most any group to year; $300,000 for the next fiscal year; State of Arkansas, that have expressed

State of Arkansas, that have expressed step up and say, "we have been acand $400,000 for the final fiscal year. themselves as fearing this is going to put

themselves as fearing this is going to put credited by thus and so”, that is recogThe committee has provided that these a strain on them to meet this require- nized by State superintendents, and then grants may be made only upon the rec- ment. I said to one of them a few days you make sure that whatever language ommendation of the National Advisory ago who expressed great concern, if we may be finally determined upon the Council on Medical, Dental, and Opto- are not able to accomplish the objective

are not able to accomplish the objective standards are not lowered. metric Education established by the bill. here why get into the program at all? Mr. HARRIS. I have given assurance In addition, the applicant school must If we are not going to meet the demands it is not the intention of lowering the have met the requirements for obtaining of an increased population, we have not. standards at all. I think a great deal a basic improvement grant.

accomplished what we started out to do. of the National League for Nursing and Our committee added two requirements All we are asking is that these very fine the American Nurses Association. They which must be met in the case of appli- medical institutions throughout the have served their purpose very well in cations for basic improvement grants, whole of the country that we are going this country. There are other regional and these requirements, of course, also to help assist us in meeting certain ob- associations that they use in connection apply to the special improvement grants, jectives.

with the higher education program. since obtaining a basic improvement There are one or two institutions-I Mr. ROGERS of Colorado. I want to grant is a prerequisite to obtaining a will not call their names—that have ex- thank and compliment the gentleman special improvement grant,

pressed the fear that this may cause for his remarks on this matter. One of these requirements is a “main- them to lose accreditation. I think that Mr. HARRIS. I thank the gentleman. tenance of effort” provision, which pro- can be taken care of. Certainly we will Madam Chairman, this bill was revides that the application must be sup- as it goes on if this fear does appear ported out of our committee unanimousported by assurances that the applicant warranted.

ly. It is a good bill and one which will will expend funds from non-Federal I think this is not too much to ask. go a long way toward meeting the demsources which are at least as great as the Certainly we are expecting that there onstrated needs in this area. We recaverage amount spent by the applicant will be cooperation, but we do not want ommend it to the House for approval. during the 3 preceding years. The to put a strain on them, and we will not. Mr. SPRINGER. Madam Chairman, I other requirement added by the com- If we find it is necessary to adjust it we yield myself 10 minutes. mittee is that the school must provide for will do so.

Madam Chairman, recognizing the an increase in its first year enrollment The other question I wanted to men

need for new and better schools in which of full-time students during the period tion was the question that was mentioned to train medical professionals, this confor which the grant is made by at least earlier during the discussion of the rule. gress 2 years ago passed H.R. 12. We 242-percent of the schools' highest first The gentleman from Colorado, of course, provided $105 million for the construcyear enrollment during the period July 1, has some concern, as others have, on this tion of new schools of medicine, $35 mil1960 through July 1, 1965, or by five stu- Rogers of Florida amendment to this bill

Rogers of Florida amendment to this bill lion for new schools of dentistry and $35 dents, whichever is greater.

affecting the nursing program. We have million for the renovation or rehabilitaThis requirement is in addition to the no intention of adversely affecting the

tion of existing facilities. This program requirement contained in section 721 standards and the criteria of nursing in- is paying off. There are 12 new schools (c) (2) which requires that construction stitutions. There was some question of various kinds in the medical field now grants may only be made if the school about the utilization, as there should be underway because of the provisions of will increase its first year enrollment by of junior colleges of the country, and it

of junior colleges of the country, and it H.R. 12. Testimony before our commit5 percent or by five students, whichever is was for that purpose that the Rogers of

was for that purpose that the Rogers of tee revealed that many more new schools greater. The way this would work is as Florida amendment was adopted. Since and many projects for the improvement follows: If a school applied for a con- the bill has been reported and since a of facilities have already been presented struction grant, and in order to obtain rule has been granted some controversy

rule has been granted some controversy for approval and there is every reason to it, it had to show an enrollment increase has developed over this matter. We have

has developed over this matter. We have believe that many others will come forof 6 students, but actually showed an in- had a general understanding that there ward. This is good news, but like much crease of 11, this would meet the require will be a record made during the course good news it indicates the necessity of ments of both the construction grant pro of the debate expressing the interest and more funds. Based upon all the facts vision and the basic and special improve concern of Members, but, as I under- that we could acquire the committee recment grant provision. In other words, stand it, the amendment to delete the ommends making available additional students counted for purposes of the con- amendment will not be offered, with the

amendment will not be offered, with the money over the next 3-year period. In struction grant program which are in ex- understanding that the matter will go on our caution with a new program the cess of the requirements of the law may through, and will be considered in the

through, and will be considered in the original legislation specified the funds also be counted against the requirements other body with a view of working it out for each kind of activity as noted above. in the basic and special improvement in conference in a way we can get the This restriction seems to be unwarranted. grants section.

greatest benefit out of the entire pro- We need facilities of many different Now, Madam Chairman, there are gram. I compliment those on both sides

gram. I compliment those on both sides kinds and it really makes no difference some schools that are fearful of this of the aisle in arriving at this agreement,

of the aisle in arriving at this agreement, whether they come into being by reason amendment that the committee adopted. and we expect to cooperate with them. of new construction or by reason of upI feel this is a good amendment and I Mr. ROGERS of Colorado. Madam grading present facilities. It also apsupported it when it was proposed by Chairman, will the gentleman yield? pears that the needs for various kinds of the gentleman from Illinois [Mr. Mr. HARRIS. I yield to the gentle- training centers have relatively equal SPRINGER), the ranking minority mem- man from Colorado.

priorities and the earmarking of funds ber.

Mr. ROGERS of Colorado. I appre- for dental schools, for example, does not The amendment would require each of ciate the statement made by the chair

ciate the statement made by the chair- really make as much sense as it appeared the schools that participates in this pro- man of the committee, and I am hopeful to when the original legislation was gram and which derives benefits from it that when the record is made it will be

that when the record is made it will be under consideration. Since H.R. 12 was to increase to some extent the doctor out- established it is not the intention of

established it is not the intention of considered here, it has been decided by this body that optometry as a profession increase in enrollment must continue for offer a challenge and rewarding careers. needs and deserves the same support as a period of years. You may recall that If he wishes to pursue that line of enthe medical skills originally included. I suggested a similar provision in the deavor known as the life sciences, and For this reason, optometrists and optom- construction authority of H.R. 12. The

construction authority of H.R. 12. The become expert in one of the many fields etry have been included in the provisions schools which have made application un

schools which have made application un- of research he can do so at very little exof H.R. 3141 across the board.

der the statute have found it possible pense to himself. Obviously this is makSince that time 2 years ago when H.R. to give such a guarantee. By adding ing it increasingly difficult to keep many 12 was so carefully considered by this this amendment to the grants section well-qualified students on the track toHouse, we have had occasion to consider we can be sure of even further additions ward a medical degree. and approve other far-reaching measures to enrollment over the years. If Fed- It is not the intention of this legisladealing with the health professions and eral support to medical school operation tion to grant free medical education to health facilities. The vital problems of will definitely increase the number of all comers. I do believe that there are the nursing profession were faced up to people being educated and the resulting many instances in which assistance in and assistance in the form of construc- number of doctors and other health pro- the form of grants, whether they be tion grants and student loans were pro- fessionals, such assistance is well justi- called fellowships or scholarships, are vided. Mental health and mental re- fied. My amendment has resulted in 63 justified. This bill would provide a fund tardation were tackled for the first time, new projects and will ultimately pro- for each medical school from which it with a new approach and a sound phi- duce 2,279 new enrollees. I am hoping could give scholarship support to a few losophy. All of these programs have de- this legislation will produce approxi- students up to $2,500 per student in any served and received the support of this mately another 2,000 new enrollees.

given year. I think that we must rely House. Much remains to be done in the In addition to these general support upon the integrity of those who operate broad field of health care for all of our grants we have provided for a series of our medical schools to maintain their citizens. The more we have considered special grants to assist schools finding it standards and to use scholarship funds the broad problems and possible solu- difficult to maintain accreditation. We for that purpose. Certainly the amounts tions the more definite it has appeared need more schools but we must also be

need more schools but we must also be anticipated in this bill will not cause an that the key to every medical and health sure that existing schools are first rate. overwhelming rush of applicants to problem facing us today will hinge on Any other kind of medical education is medical schools. It will still require dedthe creation and the assurance of ade- useless. There is no doubt that some ication, determination, and perserverquate manpower in those professions in schools will have access to more support ence, as well as outstanding intelligence the medical and allied fields. In order than others. In all likelihood the areas to become a doctor. to train such manpower we must have with the weaker schools will also be areas Earlier we talked about manpower. first-class accommodations, such as in greatest need of additional doctors. This bill is meant to increase it. We school buildings and equipment. This It is necessary in providing for any grant need more health professionals in many bill would provide them. Once the places of this type to leave considerable room different areas. Certainly we need more exist in which training can occur a new for the exercise of judgment by those general practitioners. The answer does set of problems and considerations follow charged with the administration of the not lie in dissuading qualified persons on.

act. We have laid down the general from specializing. Neither of these The competition among the various guidelines for the use of these special groups should stand in the way of teachacademic fields for highly qualified per

funds and fully expect that they will be ing. Each element of medical manpower sonnel presently works against such used to bolster the weaker institutions. is dependent upon the other and at the institutions as medical and dental Based upon experience to date and the

same time supports the others. It almost schools. Various fields of research at- projects supplied by those most knowl

projects supplied by those most knowl- becomes the chicken and egg dilemma. tract the people best suited to educate edgeable in the field we should be able to This bill should provide encouragement our doctors. Medical schools do need conclude safely that institutions for the in each of these directions and should additional funds if they are to provide training of medical personnel will grow

training of medical personnel will grow add greatly to the prospects for firstthe kind of medical education which the in number and in strength. There is an- rate medical care for every citizen. rapidly advancing profession must re- other major requirement to the produc

For these reasons I support H.R. 3141 quire. High quality instruction and ade- tion of doctors, dentists, and the other and recommend that the House pass it. quate curriculum are not things merely professionals mentioned in the bill. That

The CHAIRMAN. The time of the to be desired but to be obtained with requirement is a student body capable of

requirement is a student body capable of gentleman has expired. certainty. and motivated to the completion of a

Mr. SPRINGER. Madam Chairman, I There was a time when a State gov

course of study. We presently make yield myself 5 additional minutes. ernment could provide a medical school available loans up to $2,000 in 1 year.

Mr. NELSEN. Madam Chairman, will adequate to the needs of its particular This cannot take care of all of the ex

the gentleman yield to me? population. Those days are gone. penses at a medical school. The average

Mr. SPRINGER. I yield to the genMedical schools, particularly the bigger cost per year is about $3,500 and at many and the better ones, train doctors to schools it might be considerably more.

tleman. serve areas far removed from the bound- Many students, by the time they have

Mr. NELSEN. I would like to point aries of a particular State. To meet reached medical school, have borrowed

reached medical school, have borrowed out that the requirement in the bill that this situation H.R. 3141 provides for large sums of money. They must have will insist on the expansion of the engrants to all medical schools which after this undergraduate training and they

this undergraduate training and they rollees is the amendment that was ofthe first year would provide $25,000 plus must prove themselves to be worth the fered, I believe, by the gentleman in the $500 per student enrolled. This should time and the efforts of the graduate

time and the efforts of the graduate well. I want to point out that certainly make it possible for schools to compete school. school. The student of limited means

this is a very constructive approach and on more even terms for faculty members. applying for admittance

for admittance to medical

a much needed amendment to this bill. If such assistance is to be granted with school, after struggling to obtain his

school, after struggling to obtain his I might point out further that in our Federal funds it is my conviction that college education, faces formidable ex

hearings in our committee it was obvious there should be some assurance that we pense. Although he may be able to ob

that the need for doctors, especially in will end up with more doctors. By this tain the full $2,500 per year—the amount

tain the full $2,500 per year—the amount rural areas, is a crying need and one I mean that we should make certain provided in this bill—he will still be

provided in this bill—he will still be which we must try to meet. that upon spending these millions of short. There must come a time when I want to thank the gentleman for his dollars to support the operations of pro- the student surveys his obligations and

the student surveys his obligations and statement and for reaching the objective fessional schools, we will train more peo- decides that he has had enough. Even

decides that he has had enough. Even he sought by his amendment. I believe ple than would have been trained if this the challenge and the possible rewards of

the challenge and the possible rewards of it is a very worthwhile contribution to specific assistance had not been given the medical profession will cease to give this legislation. For this reason I suggested and the com- him the necessary incentive. Partic

Mr. SPRINGER. Madam Chairman, mittee adopted an amendment which re- ularly is this true when we consider other I want to thank the distinguished genquires that any school applying for possible fields of endeavor into which he

possible fields of endeavor into which he tleman for his words and say even grants under this section must agree to might channel his ambition. There are

might channel his ambition. There are though it was my amendment, I believe increase its enrollment by 212 percent or grants, traineeships, and fellowships it was unanimously accepted in 1963 and 5 students, whichever is greater. This open to graduate students. They also again this year on both sides of the aisle. 5

Now, a lot of you are wondering here. of work in trying to work out some kind is an M.D. in the State of Kentucky. He, This is a lot of money. Over this period of mandatory arrangement whereby we himself, had no scholarship, but he did of years from 1963 and through the pe- could get these doctors in rural areas. have some money and did get some loans riod we authorize here it will run up- In wrestling with this task we found and he did repay them. The scholarwards of $800 million to $1 billion before that it was an almost impossible situa- ship was for an entirely different purwe get through with this program, if we tion. We did find, for instance, that in pose, to help those who had absolutely do not do any more to it. Can we expect the State of Mississippi and one or two no money. There the only solution was that we are going to have a greater num- others they were successful in inducing this. ber of doctors per 1,000? I wish I could them to come in under a State plan. Mr. HALL. Madam Chairman, will assure you that it is true, but the best we did not feel that we could make a the gentleman yield? estimate we can get, even with the in- workable national plan, if the gentleman Mr. SPRINGER. I yield to the gentlecrease we are expecting to get, even from wants to know the truth about it. That man from Missouri. the results of H.R. 12 in 1963 and H.R. is the reason why we did not do it. We Mr. HALL. I appreciate the gentle3141 in 1965, the best we can hope to do did not think it would be workable. man's yielding. I simply seek a point is stay approximately even on this score. I come from a rural area where there of clarification and perhaps a reference. That means approximately the same is a shortage of doctors and I wanted to I have read the hearings and the report number of doctors per 1,000 population come up with some kind of a plan, but and I am concerned about the gentlein this country that we have at the pres- we just could not get a workable plan.

we just could not get a workable plan. man's statement, who is in the well of the ent time is what we will have by 1972. Mr. HARRIS. Madam Chairman, will House, because I know he takes full seriI believe for this reason this program the gentleman yield?

ously the public care of people in a qualwas urgently needed in 1963 and I sup- Mr. SPRINGER. I yield to my dis- ity fashion in the United States. I have ported it then. For the same reason I tinguished chairman.

reference to medical schools that are on am supporting it in 1965.

Mr. HARRIS. On the point just men- the verge of collapse. I do not find any Mr. JONES of Missouri. Madam tioned, it will be remembered also that reference to that either in the hearings Chairman, will the gentleman yield for a bill was reported from the committee to or in the report.

or in the report. Quite to the contrary, a question?

provide this incentive that we discussed my information is that for the first time Mr. SPRINGER. I yield to the dis- on the floor of the House, and because of in many years we have no substandard tinguished gentleman from Missouri. the opposition to it the House did not medical schools that are expanding.

Mr. JONES of Missouri. Do you approve the bill. It was defeated by a The number, as the gentleman points think you are going to get any more very small vote.

out, is growing. We are turning out more students under a grant program than Mr. SPRINGER. That escaped my and more doctors. I just wonder if the under a scholarship program or, to put attention, but since the chairman has re- gentleman can cite the record. it another way, would not a loan pro- called it, I know that he is stating the Mr. SPRINGER. I cannot give the gram do the job if you could not get fact.

gentleman the exact figures. enough students to fill all of the facili- Mr. JONES of Missouri. Mr. Chair- Mr. HALL. I do not know that I ties you are going to have for training man, has any consideration been given should want the gentleman to do that. these people?

to the anticipated income of doctors as Mr. SPRINGER. I can tell you this Mr. SPRINGER. That was a point compared with graduates from other in numbers; there are 10 medical schools we went into in some detail. There was schools, other professions? The pay of in number, and 3 dental schools are on some conflicting testimony on this. May a doctor, when he gets out into practice, the provisional accreditation list. I say that taking into consideration all is greater than the average, and would Mr. HALL. This is accreditation by of these factors, there will probably be he not be in a better position to repay which body, if the gentleman knows? enough applicants to fill all the positions a loan than would many other people? Mr. SPRINGER. I will have to yield regardless of whether or not we did this Mr. SPRINGER. I think the gentle- to my chairman on that, but I assume at all, but we were made very aware of man probably has a point there. This it was the American Medical Association. the fact that there were a great many was a matter of discretion. We did Mr. HARRIS. Madam Chairman, if highly qualified students without funds feel that the number of years it takes the gentleman will yield there is a referwho want to become doctors.

to produce a doctor, a good one, was ence to this at page 16 of the report. It is As to the second point, as to grants, greater than to produce a graduate of stated there as follows: I believe in the Education Act that they another profession with a doctor's de

Testimony presented to the committee incalled them outright grants. In this bill gree. I think that is true. Customarily, dicates that a small number of medical we call them scholarships. I suppose

I suppose when a doctor graduates and goes schools are so weak and poorly financed that we could have used the word “grant" but through his internship and into speciali- it is doubtful that they can continue to prowe did not.

zation, it is a matter of 10 to 12 years. vide acceptable education without more inMr. JONES of Missouri. What is the Another man may get a doctor's degree stitutional support. difference? in 7 years.

Mr. HALL. Madam Chairman, if the Mr. SPRINGER. There is no dif- Mr. JONES of Missouri. It has been gentleman will yield further, would the ference. The effect of the scholarship my observation that the average doctor, distinguished chairman, without menand the grant are identical. On the after he gets out of school, in a very tioning the names of the institutions, tell loans we did feel there were many—and short time has an income of up to and me the source of that testimony? That the American Medical Association testi- more than $20,000 a year. Certainly he is all I am seeking. fied to this 2 years ago—there were many should feel some obligation to pay back Mr. HARRIS. It came from the Asstudents in schools who ought to be giv- the money he has borrowed. I, for one, sociation of American Medical Schools ing more time to it rather than working am not going to vote to provide any itself and it is included in the report. at some other job. In other words, they grants when loans would accomplish the Also, it is included in the hearings and ought to be working at this. It was the same objective.

I shall be glad to look it up and refer feeling that many of those students did Mr. SPRINGER. I recognize the value the gentleman to it. not want to get a scholarship, but it was of what the gentleman has said. From Mr. HALL. As I say, I have looked necessary to get a loan and they were the evidence before our committee we through the hearings and I am familiar perfectly willing to qualify for a loan had the feeling, in the first place, that with the situation and the competition, and to pay it back.

there were many students who were if I may use that word, between the AsMr. JONES of Missouri. Was any smart but simply had no funds and sociation of Medical Schools, the Assoconsideration given to any obligation on probably would never become doctors ciation of Deans of Medical Colleges, the the part of a graduate going into these without this kind of assistance.

Hospital Association and the Council on rural areas, as was stated, where the As to the loan situation, that is a Education of the American Medical Assoneed was great?

little different. Generally the man has ciation which does actually accredit these Mr. SPRINGER. May I say that we some money and he adds that loan in schools. did. The gentleman from Mississippi order to supplement his money. This is I am of the opinion that perhaps in (Mr. WILLIAMS]—and I wish he were here what Dr. Carter of our committee men- the spirit of the chase or for emphasis, we to discuss it with you—and I did a lot tioned in the discussion of this bill. He can well believe that perhaps none of our

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